401k Plan data: AA ASPHALTING, INC. HEALTH BENEFITS PLAN plan

AA ASPHALTING, INC. HEALTH BENEFITS PLAN 401k Plan overview

Plan Name	AA ASPHALTING, INC. HEALTH BENEFITS PLAN
Plan identification number	501

AA ASPHALTING, INC. HEALTH BENEFITS PLAN Benefits

401k Plan Type

Welfare Benefit

Plan Features/Benefits

Health (other than dental or vision)
Life insurance
Dental
Vision
Temporary disability (accident and sickness)
Long-term disability cover
Death benefits (include travel accident but not life insurance)
Other welfare benefit cover
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

AA ASPHALTING, LLC has sponsored the creation of one or more 401k plans.

Company Name: AA ASPHALTING, LLC

Employer identification number (EIN): 911020538

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AA ASPHALTING, INC. HEALTH BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 MATTHEW D. ATTEBERY 2024-04-19
501 2022-01-01 MATTHEW D. ATTEBERY 2023-06-22
501 2021-12-01 MATTHEW D ATTEBERY 2022-10-06
501 2020-12-01 MATTHEW ATTEBERY 2022-09-13
501 2019-12-01 MATTHEW D. ATTEBERY 2021-04-30
501 2018-12-01 KAREN ERICKSON 2020-03-27
501 2017-12-01 STACY ROSS 2019-03-30
501 2016-12-01 STACY ROSS 2019-03-05
501 2015-12-01 STACY ROSS 2019-03-05
501 2014-12-01
501 2013-12-01
501 2012-12-01
501 2009-12-01 JEFF JEWETT
501 2008-12-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	MATTHEW D. ATTEBERY	2024-04-19
501	2022-01-01	MATTHEW D. ATTEBERY	2023-06-22
501	2021-12-01	MATTHEW D ATTEBERY	2022-10-06
501	2020-12-01	MATTHEW ATTEBERY	2022-09-13
501	2019-12-01	MATTHEW D. ATTEBERY	2021-04-30
501	2018-12-01	KAREN ERICKSON	2020-03-27
501	2017-12-01	STACY ROSS	2019-03-30
501	2016-12-01	STACY ROSS	2019-03-05
501	2015-12-01	STACY ROSS	2019-03-05
501	2014-12-01
501	2013-12-01
501	2012-12-01
501	2009-12-01	JEFF JEWETT
501	2008-12-01

Form 5500 Responses for AA ASPHALTING, INC. HEALTH BENEFITS PLAN

2023: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2021 form 5500 responses
2021-12-01	Type of plan entity	Single employer plan
2021-12-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-12-01	Plan funding arrangement – Insurance	Yes
2021-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-12-01	Plan benefit arrangement – Insurance	Yes
2021-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2020 form 5500 responses
2020-12-01	Type of plan entity	Single employer plan
2020-12-01	Plan funding arrangement – Insurance	Yes
2020-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-12-01	Plan benefit arrangement – Insurance	Yes
2020-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2019 form 5500 responses
2019-12-01	Type of plan entity	Single employer plan
2019-12-01	Plan funding arrangement – Insurance	Yes
2019-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-12-01	Plan benefit arrangement – Insurance	Yes
2019-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2018 form 5500 responses
2018-12-01	Type of plan entity	Single employer plan
2018-12-01	Plan funding arrangement – Insurance	Yes
2018-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-12-01	Plan benefit arrangement – Insurance	Yes
2018-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2017 form 5500 responses
2017-12-01	Type of plan entity	Single employer plan
2017-12-01	Plan funding arrangement – Insurance	Yes
2017-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-12-01	Plan benefit arrangement – Insurance	Yes
2017-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2016 form 5500 responses
2016-12-01	Type of plan entity	Single employer plan
2016-12-01	Plan funding arrangement – Insurance	Yes
2016-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-12-01	Plan benefit arrangement – Insurance	Yes
2016-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2015 form 5500 responses
2015-12-01	Type of plan entity	Single employer plan
2015-12-01	Plan funding arrangement – Insurance	Yes
2015-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-12-01	Plan benefit arrangement – Insurance	Yes
2015-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2014 form 5500 responses
2014-12-01	Type of plan entity	Single employer plan
2014-12-01	Plan funding arrangement – Insurance	Yes
2014-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-12-01	Plan benefit arrangement – Insurance	Yes
2014-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2013 form 5500 responses
2013-12-01	Type of plan entity	Single employer plan
2013-12-01	Plan funding arrangement – Insurance	Yes
2013-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-12-01	Plan benefit arrangement – Insurance	Yes
2013-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2012 form 5500 responses
2012-12-01	Type of plan entity	Single employer plan
2012-12-01	Plan funding arrangement – Insurance	Yes
2012-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-12-01	Plan benefit arrangement – Insurance	Yes
2012-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2009 form 5500 responses
2009-12-01	Type of plan entity	Single employer plan
2009-12-01	Submission has been amended	No
2009-12-01	This submission is the final filing	No
2009-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-12-01	Plan is a collectively bargained plan	No
2009-12-01	Plan funding arrangement – Insurance	Yes
2009-12-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-12-01	Plan benefit arrangement – Insurance	Yes
2009-12-01	Plan benefit arrangement – General assets of the sponsor	Yes
2008: AA ASPHALTING, INC. HEALTH BENEFITS PLAN 2008 form 5500 responses
2008-12-01	Type of plan entity	Single employer plan
2008-12-01	First time form 5500 has been submitted	Yes
2008-12-01	Submission has been amended	No
2008-12-01	This submission is the final filing	No
2008-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-12-01	Plan is a collectively bargained plan	No

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

384785

Policy instance

Insurance contract or identification number	384785
Number of Individuals Covered	118
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,971
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $80,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

384785

Policy instance

Insurance contract or identification number	384785
Number of Individuals Covered	113
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,147
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $75,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

384785

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30022891

Policy instance

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4012684

Policy instance

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4012684

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

384785

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30022891

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30022891

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

384785

Policy instance

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4012684

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30022891

Policy instance

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4012684

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

384785

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30022891

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

384785

Policy instance

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4012684

Policy instance

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

10013101

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30022891

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00384785

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00384785

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00384785

Policy instance

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

10013101

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47317 )

Policy contract number

30022891

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00384785

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30022891

Policy instance

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

10013101

Policy instance

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Company Name:	AA ASPHALTING, LLC
Employer identification number (EIN):	911020538
NAIC Classification:	238900